Doctor Name: | CYNTHIA JEAN HARRIS MADDOX |
NPI Number: | 1174893671 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | IMHO 9429 |
Business Practice Address: | 316 Scotland Dr Holly Hill, FL - 321174254 |
Business Phone Number: | 3862553741 |
Business Fax Number: | |
Mailing Address: | 316 Scotland Dr, HOLLY HILL |
State: | FL |
Postal Code: | 321174254 |
Phone Number: | 3862553741 |
Fax Number: | |
NPI Enumeration Date: | 12/31/2011 |
NPI Last Update Date: | 12/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMHO 9429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |